晨间床边护理查房模式在神经内科的应用

目的探讨晨间床边护理查房在神经内科的应用效果。方法每天早交班后,由护士长主持,围绕病区患者的情况进行30～40 min的床边查房。结果神经内科实施晨间床边护理查房后,患者满意率由87.50%上升至98.04%,护士专科知识掌握率由实施前的76.00%上升至96.00%;护士病情知晓率由84.00%上升至100%。实施后护理质量提升;护士寻求真相、分析能力、求知欲评分及评判性思维总分较实施前显著提高(P<0.05,P<0.01)。结论神经内科护士长晨间护理查房对提高临床护理质量、护士业务水平、评判性思维能力以及患者的满意度起到积极的促进作用。     

提高骨科护士床边交接班质量的规范化管理

目的探讨规范培训提高骨科护士床边交接班质量的效果。方法规范床边交接班流程和内容,制定《骨科护士床边交接班评分表》;分析床边交接班存在的问题,以骨科代表性病种"脊椎损伤并截瘫"、"髋关节置换术后"拍摄交接班视频,制作交接班思维导图、编制交接班顺口溜;采取理论授课、播放交接班视频、情景模拟交接班等形式,对骨科护士开展床边交接班培训。结果交接班项目中除"专科情况"外,其他项目培训后得分显著高于培训前(均P<0.01)。结论规范培训能显著提高骨科护士床边交接班质量。     

基于以患者为中心的床旁交接班流程优化

目的探讨床旁交接流程优化在优质护理示范病房的实施及效果。方法分析原有床旁交接班流程存在的不足,对交接班前准备、交接内容、形式、质量督察等进行流程优化,并以自行设计的交接班流程现状调查表及交接质量督察进行评价。结果3个月后,患者对护士床旁交接班的总体评价显著优于流程优化前(P<0.05),床旁交接班质量提高。结论床旁交接班流程优化增强了护患沟通,提高了患者满意度及交接班质量。     

护士反式交接班的实施与效果

目的创新实施反式交接班模式,评价其实施效果。方法改变传统交接班模式,变接班者为交班者,由接班护士汇报患者情况,交班护士给予补充(反式交接班)。结果反式交接班模式未延长交接班时间,但在此模式下患者满意度显著提高(P<0.01)。结论反式交接班模式可提升接班护士责任心,促使护士落实责任制整体护理,从而提高患者满意度。     

改良SBAR交接班在口腔门诊的应用

目的探讨改良SBAR交接班在口腔门诊的应用效果。方法基于SBAR沟通模式,结合口腔门诊患者和护理工作的特点,设计改良SBAR口腔门诊护理交接工作表,建立并应用改良SBAR交接班模式。结果改良SBAR交接班实施前交班质量评分为(84.93±3.70)分,实施后为(91.14±4.13)分,实施前后比较,差异有统计学意义(P0.01);实施后护士对交接班工作满意度评分除"我发现交班不会花费太多时间"外,其他条目得分显著高于实施前(P0.05,P0.01);医生对接班护士满意度显著高于实施前(P0.01)。结论改良SBAR交接班有效提高了口腔门诊护理交接班质量,使护士对交接班工作的满意度和医生对护士工作的满意度有所提高。     

标准化护理操作规程管理在提升肾移植术后护理质量及患者满意度中的作用

目的探讨标准化护理操作规程管理在提升肾移植术后护理质量及患者满意度的作用。方法通过实施标准化护理操作规程,对实施前后肾移植科发生的护理工作缺陷率、护理质量以及患者满意度进行统计分析。结果实施标准化护理操作规程后,护理工作缺陷率为4.88%,远低于实施前(24.39%);护理质量的5个方面评分均高于实施前,P<0.05;患者满意度在4个方面的得分均高于实施前,差异具有统计学意义。结论实施标准化护理操作规程,可以提高肾移植科的护理质量,提升患者的满意度,减少甚至避免护理不良事件的发生。     

实施责任制护理对护士工作责任感的影响

目的探讨实施责任制护理对提高护士工作责任感及患者满意度的影响。方法选取2个病区开展责任制护理实践,包括分组按层级排班、责任制包干及加强支持性管理等,并以自制的护理人员的责任感问卷和住院患者满意度问卷进行评价。结果实施1年后,护士工作责任感及住院患者满意度显著提高(P<0.05,P<0.01)。结论开展责任制护理改革,可明显提高护士的工作责任感,进而提高患者的满意度。     

手术室工时制量化管理的实施与成效

目的探讨手术室工时制量化管理的实施效果。方法除按岗位系数、职称系数、工作质量考核分配外,对手术工作量进行工时制量化考核,每个月进行综合评价,比较实施前后护理质量和医患满意度。结果实施后护理质量评分及医生、患者、护士满意度显著优于实施前(P<0.05,P<0.01)。结论手术室实施工时制量化考核,调动了护士的工作积极性,提高了工作质量,提升了患者、医生和护士的满意度。     

神经外科表格式交班本的改进及其应用

目的探讨表格式交班本改进后在神经外科交接班中的应用效果。方法将重点巡视的内容、病情观察要点、特殊治疗项目以及患者安全等作为交班内容罗列到表格式交班本中,应用于临床护理交接班。结果改进后护士对病区、患者病情的掌握情况,护理措施落实率及患者满意度显著高于改进前(P<0.05,P<0.01)。结论表格式交班本经改进后更有利于护士有重点地掌握病区情况,及时落实护理措施,保障患者安全,提高患者满意度。     

I-PASS病情汇报模式在CICU护士交接班中的应用

目的探讨I-PASS病情汇报模式在CICU护士交接班中的应用效果。方法将2015年1~6月CICU收治的809例患者作为对照组,采用传统的床边口头交接班;7~12月收治的867例作为观察组,采用I-PASS病情汇报模式交接班。结果观察组交接班问题中病情交接不完整、治疗或护理措施遗漏发生率显著低于对照组,护士和患者对交接的满意度显著高于对照组(均P0.01)。结论以I-PASS病情汇报模式进行交接班,可提高护士交接班质量,保障患者安全,提高护士和患者的满意度。     

管床评分表在责任制护理实施中的应用

目的探讨管床评分表在责任制护理实施中的应用效果。方法在开展优质护理服务示范病房活动中实施管床责任制护理,应用自制的管床评分表对责任护士进行评分并纳入绩效考核。结果应用管床评分表后患者对护理服务满意率、医生满意率、护士对患者十知道掌握情况较应用前显著提高(均P<0.01)。结论管床评分表具有导向作用,有助于指导责任护士开展责任制护理,同时纳入绩效管理,增强了护士责任心和积极性,从而提高护理质量和患者满意度。     

中文版患者床边交班感知量表的信效度研究

目的翻译患者床边交班感知量表（PVNC-BR）,并初步评价其信度与效度。方法严格遵循翻译-回译-专家咨询步骤对量表进行跨文化调试,并通过对138例患者进行调查,检测中文版PVNC-BR的信效度。结果探索性因子分析共提取3个公因子,17个条目,累积贡献率为61．043％,各因子的负荷数为0．413～0．861;Cronbach’sα系数为0．821,各因子的Cronbach’sα系数为0．696～0．854;重测信度为0．879,各因子的重测信度为0．771～0．922。结论中文版PVNC—BR量表具有较好的信度、效度,符合心理学测量要求,可用于测评实施床边交班患者的感知评价。     

中文版患者床边交班感知量表的信效度研究

目的翻译患者床边交班感知量表(PVNC-BR),并初步评价其信度与效度。方法严格遵循翻译-回译-专家咨询步骤对量表进行跨文化调试,并通过对138例患者进行调查,检测中文版PVNC-BR的信效度。结果探索性因子分析共提取3个公因子,17个条目,累积贡献率为61.043%,各因子的负荷数为0.413~0.861;Cronbach′sα系数为0.821,各因子的Cronbach′sα系数为0.696~0.854;重测信度为0.879,各因子的重测信度为0.771~0.922。结论中文版PVNC-BR量表具有较好的信度、效度,符合心理学测量要求,可用于测评实施床边交班患者的感知评价。     

ICU护士对SBAR交班内容认可的调查

目的了解ICU护士对SBAR交班内容认可情况,并分析其影响因素,为推广应用SBAR交班模式提供参考。方法采用自制问卷对6所三级甲等医院ICU护士306人进行调查,调查内容涉及交班的主要内容,即主观问题、背景、评估及建议。结果ICU护士对SBAR交班内容赞同总分为(4.38±0.52)分,4个维度得分均高于4分;12h工作制护士的主观问题维度得分显著高于8h工作制护士;不同ICU类型护士对SBAR交班内容赞同总分及各维度得分比较,差异有统计学意义(均P0.01)。结论ICU护士对SBAR的交班内容比较赞同,有利于推广SBAR交班系统,尤其是外科ICU。在推广SBAR过程中应加强对护士进行专业知识培训,提高护士临床决策能力及专业素养,促进有效的交班。     

急诊床旁超声在腹部损伤中的应用价值

目的 了解急诊床旁超声在腹部闭合性损伤中的应用价值.方法 回顾性分析67例腹部闭合性创伤超声影像资料.结果 所有患者行急诊床旁超声检查,诊断符合率分别为:肝损伤92%,脾损伤93%,肾损伤80%,胰腺损伤50%,空腔脏器损伤67%,肠系膜血管损伤100%,腹膜后血肿100%.结论 急诊床旁超声是诊断腹部创伤致内脏破裂出...     

Rotational thrombelastometry for the bedside monitoring of recombinant hirudin

Background: Recombinant hirudin is used as an alternative anticoagulant, particularly in patients with heparin-induced thrombocytopenia type II. However, bedside monitoring for hirudin is not available. The present study aims to evaluate rotational thrombelastometry regarding its suitability to detect the effects of recombinant hirudin on whole blood coagulation. Hirudin was added to whole blood samples from healthy donors ( n =5) and thrombelastometry variables resulting from activation of samples with tissue factor, ellagic acid, and ecarin were determined.
Methods: Hirudin (0.1–10 μg/ml) was added to citrated blood. Thereafter, rotational thrombelastometry was performed by initiating coagulation via recalcification and addition of tissue factor, ellagic acid, and ecarin, respectively, using the commercially available assays.
Results: In the absence of hirudin, clotting times (CT) induced by ellagic acid, tissue factor, and ecarin, respectively, were 141.7±18.0, 54.0±7.6, and 64.5±4.1 s. Increasing concentrations of hirudin led to dose-dependent prolongation of the clotting time with the three activators. All assays were capable to detect hirudin concentrations in the range of 0.5–5 μg/ml. At a final hirudin concentration of 1 μg/ml, clotting time increased to 268.0±25.1, 84.0±9.3, and 107.5±9.9 s, respectively, with the above-mentioned activators. The other thrombelastographic variables, including clot formation time, angle α, and maximum clot firmness, were not altered by hirudin at concentrations up to 5 μg/ml.
Conclusions: Our study demonstrates the suitability of rotational thrombelastometry to detect anticoagulant effects of recombinant hirudin.     

责任小组制整体护理模式中交接班的改进

目的探讨责任小组制整体护理模式中交接班的改进。方法设计交接班工具,改进交接班流程,比较改进前后效果。结果患者病区跌倒和压疮发生率分别由0.44%和0.59%降至0.13%和0.25%,交接班时间显著缩短,护士对患者整体情况的知晓度,各项护理措施落实评分及患者满意度显著提升(均P<0.05)。结论改进后的交接班方式有利于提高工作效率和患者满意度。     

Detection of postoperative myocardial ischemia by bedside ST-segment analysis in coronary artery bypass graft patients

To determine if the ST-segment monitoring software of a bedside electrocardiograph (ECG) monitor would detect postoperative myocardial ischemia (POMI) as reliably as the clinical gold standard 12-lead ECG, and to compare the characteristics of ischemia thus detected with prior studies performed using Holter monitoring. Prospective study. University hospital. One hundred patients who had undergone coronary artery bypass grafting (CABG). Continuous ST-segment trends in leads II and V₅ were recorded using Hewlett-Packard Merlin monitors postbypass until discharge from the postsurgical unit, and printouts were analyzed for episodes of ischemia. Simultaneous 12-lead ECGs and monitor strips were recorded during ischemic episodes in 24 patients and were independently analyzed by two blinded cardiologists quantitatively for ST-segment values and qualitatively for an overall ischemia rating.

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The ST-segment values directly measured by the cardiologists on the simultaneous 12-lead ECGs and those recorded by the monitor during ischemic episodes were found to be clinically comparable (bias, 0.1 mm for both leads; precision, 0.5 mm lead II, 0.9 mm lead V₅). The sensitivity of the monitor compared with 12-lead ECGs for the detection of POMI was 73%. Ninety eight episodes of significant ST deviation were identified in 39 patients. The characteristics of the ischemia detected in this study were similar to those reported in other studies performed using continuous Holter-type monitoring. Bedside monitoring of the ST segment in leads II and V₅ using Hewlett-Packard Merlin monitors after CABG surgery is as accurate for the measurement of ST deviation in those leads as the clinical gold standard of a 12-lead ECG read by an experienced cardiologist. However, the 12-lead ECG will detect POMI more reliably than an automated two-lead bedside ST-segment analyzer because it allows evaluation of more leads and of ST-segment and T-wave morphology. Bedside ST-segment monitoring in this study confirmed the high incidence of ischemia after CABG surgery shown previously using Holter monitoring.